三种输卵管妊娠保守治疗方法妊娠结局临床比较分析

Comparative analysis of pregnancy outcome of ectopic pregnancy treated by three different kinds of fallopian tube conservative treatment

目的对比分析药物终止妊娠保守治疗、腹腔镜下保留输卵管手术治疗及经腹保留输卵管手术治疗输卵管妊娠的疗效及患者生育结局。方法选择我科2009年3月至2014年3月期间输卵管妊娠患者523例,据患者情况及意愿分为药物终止妊娠组(药物组)203例,腹腔镜下保留输卵管手术(腔镜组)163例,经腹行保留输卵管手术组(开腹组)157例,比较三组患者血人绒毛膜促性腺激素(HCG)值降至正常时间、输卵管复通率、再次异位妊娠、宫内妊娠结局、总住院时间、总住院费用。结果药物组的住院时间[(20.15±4.02)d vs.(5.21±3.05)d vs.(7.45±2.89)d]及血β-HCG降至正常时间[(19.34±4.02)d vs.(6.89±2.02)d vs.(7.17±1.92)d]最长,住院费用最少,而其治愈率(74.88%vs.98.16%vs.98.73%)却最低。经卡方检验,与腔镜组和开腹组比较差异有统计学意义(P<0.05)。经过治疗后发现,腔镜组患侧输卵管畅通率(91.7%vs.55.0%vs.75.8%)及宫内妊娠率(76.9%vs.49.5%vs.65.2%)明显高于药物组及开腹组,而继发不孕率最低(15.7%vs.40.4%vs.26.3%),具有统计学差异(P<0.05);三种治疗方法的再次异位妊娠率差异不明显(7.4%vs.10.1%vs.8.4%),无统计学意义(P>0.05)。结论在患者自身条件及医院条件允许的情况下,对于有生育要求的输卵管妊娠患者,腹腔镜下保留输卵管的保守性手术应是最佳治疗方案。

Objective： To comparatively analyze the pregnancy outcome after treatment of tubal pregnancy by the three different kinds of tube conservative treatment including use of drugs to terminate a pregnancy, laparoscopic or abdominal oviduct-sparing operation. Methods： A total of 523 tubal pregnancy patients were included in the study in our department from March 2009 to March 2014,and divided into three groups：group A（use of drug to terminate a pregnancy, 203 patients）, group B （laparoscopic oviduct-sparing operation, 163 patients）and group C （abdominal oviduct-sparing operation,157 patients）. The data including time of HCG levels in blood to decrease to normal, fallopian tube recanalization rate, ectopic re-pregnancy rate, intrauterine pregnancy rate, total time of hospitalization,hospitalization expenses were compared among the three groups. Results： The hospital stay days[（20.15±4.02）vs. （5.21±3.05）vs. （7.45±2.89）days] and the time of HCG levels in blood to decrease to normal [（19.34±4.02）vs. （6.89±2.02）vs. （7. 17±1.92）days] were the longest,and the hospitalization expense and recovery rate（74.88% vs. 98.16% vs. 98.73%）were the lowest in group A compared with group B ＆ C（P〈0.05）. The fallopian tube recanalization rate（91.7% vs. 55.0% vs. 75.8%） and the intrauterine pregnancy rate （76.9% vs. 49.5% vs. 65.2%） were significantly higher, but the secondary infertility rate was significantly lower in group B than those in group A ＆ C（P〈0. 05）. The ectopic re-pregnancy rate had no significant difference among the three groups（P〉 0. O5）. Conclusions： If the conditions of patients and hospital were available, laparoscopic conservative operation is the optimal treatment method for the patients with tubal pregnancy who have fertility desire.